An Update on Pediatric Covid Deaths

In January 2023, JAMA Network Open published a paper that said Covid was "a leading cause of death" in children and young people in the US. Time to look at the latest data.

For the week of Thanksgiving, I thought I would share some updates with good news about decreasing Covid mortality in the US. This article provides an update on the oft-cited claim that Covid is the 8th leading cause of death and the leading infectious disease killer in kids.

I have been tracking pediatric Covid mortality in the US since early on, and I have responded to many claims about kids and Covid in that time. But no paper has garnered more attention on this topic than a paper by academics from University of Oxford and Imperial College that claimed Covid was a leading cause of death in children and young people in the US. The article below about the study has been shared widely on social media by Peter Hotez, Lisa Iannattone, and others.

University of Oxford: COVID-19 is a leading cause of death in children and young people in the US

An early pre-print of the paper that incorrectly claimed Covid was a top 5 cause of death in all pediatric age groups was originally cited by the CDC in ACIP and FDA VRBPAC meetings to approve pediatric vaccines. I promptly debunked those claims, and the paper was re-written as a result of my criticism. I also responded to the published version of the paper in January 2023, which was based on Covid deaths during August 2021 - July 2022. Now that we have data from the following 12-month period, I thought it was time to re-run the numbers.

NOTE: While I have issues with the use of the 0-19 age group, which the study authors refer to as “children and young people” in their paper, instead of the more traditional pediatric age grouping of 0-17, I re-analyzed the data for the same 0-19 age group used in the study for consistency.

Overall Leading Causes of Death

The study authors ranked Covid deaths for ages 0-19 years from August 2021 - July 2022 against 2019 leading cause of death totals to show that Covid was the 8th leading cause of death among this age group. Below, I graphed rolling 12-month Covid death totals for ages 0-19 using the latest data from CDC WONDER. The time period used in the study appears in the graph below by the ending month (July 2022). This was the peak 12-month death total for this age group as you can see in the graph.

The rolling 12-month death total fell sharply after July 2022, as the deaths from the Delta wave in Aug/Sept 2021 were no longer included in the 12-month total. The 12-month total fell sharply again in January 2023, as the Omicron peak in January 2022 was no longer in the 12-month total. As long as deaths remain lower than the same month in the prior year, the 12-month rolling totals will continue to decline.

I also included reference lines of the 7th-10th leading causes of death from 2019, so that you can see how the Covid ranking rose and fell compared to 2019 deaths:

• From September 2021 - December 2022, Covid ranked 8th compared to 2019.

• From January - May 2023, Covid ranked 9th compared to 2019.

• In June 2023, Covid ranked 10th compared to 2019.

• From July 2023 on, Covid is no longer a top 10 cause of death when ranked alongside 2019 leading causes.

Beginning with the same August 2022 - July 2023 time period, Covid is also no longer a top 10 cause of death in ages 0-19 compared to other deaths from that time period (instead of comparing to 2019 data). Here’s where Covid ranks among some of the other causes of death from August 2022 - July 2023:

7. Heart Disease (788)

8. Flu & Pneumonia (546)

9. Sepsis (315)

10. Stroke (273)

11. Covid-19 (261)

Covid accounted for only 0.6% of deaths in ages 0-19 during the August 2022 - July 2023 time period, compared to 1.9% of deaths during the peak period used in the study.

Leading Infectious Causes of Death

The paper also found that Covid was ranked “first in deaths caused by infectious and respiratory diseases” for children and young people during the peak time period used in the study.

This is also no longer the case for the period August 2022 - July 2023 (one year after the time period used in the paper). During this 12-month period, Covid-19 was listed as the underlying cause of 261 deaths (crude rate 0.3 per 100,000), which would rank 6th in the table below from the paper, behind “influenza and pneumonia”, “other and unspecified infectious and parasitic diseases and their sequelae”, “other diseases of the respiratory system”, “pneumonia,” and “septicemia” (sepsis).

Leading Causes of Death by Age Subgroups

Finally, I thought it was worth noting that death by age within children and young people have shifted significantly from the study period (August 2021 - July 2022) to the same period a year later. Deaths fell in every age subgroup, but they have fallen more sharply in those ages 5 and older. In the study period, deaths were highest in the 15-19 age group and lowest in the 5-9 age group. A year later, deaths were lowest in the 10-14 age group and highest in the <1 year age group.

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Final Thoughts…

One of my issues with the published paper was that must have known that they were using the absolute peak time period for Covid deaths in this age group, by including both the Delta and initial Omicron waves. Almost half of the deaths in the 12-month period used in the paper occurred in just three unusual months — August ’21, September ’21, and January ’22. But their conclusions were written as if it were the “new normal” that Covid would deaths would remain at that level without interventions.

What the data shows instead is that deaths dropped sharply after the initial Omicron wave peaked in January 2022. When the paper came out in January 2023, the 12-month total of Covid deaths for ages 0-19 was already half of what it was during the period used in the paper, with Aug./Sept. 2022 deaths just a third of the Delta wave in Aug./Sept. 2021. We later saw that deaths for ages 0-19 in January 2023 were a fifth of January 2022. Yet even now, in November 2023, people are still citing this outdated and misleading paper as if nothing has changed. It’s time to put these claims to rest — Covid is no longer a top 10 leading cause of death or the leading infectious cause of death in children and young people (age 0-19) in the US.

Also see my follow-up article from this week on overall Covid mortality in the US: